Provider Demographics
NPI:1336880111
Name:LAYMAC, MADELEINE
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:LAYMAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 EVERNIA ST APT 207
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5446
Mailing Address - Country:US
Mailing Address - Phone:770-769-6608
Mailing Address - Fax:
Practice Address - Street 1:641 UNIVERSITY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2794
Practice Address - Country:US
Practice Address - Phone:561-253-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
FLPA9115712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care